Barriers and facilitators to viral load suppression among adolescents and young people living with HIV receiving intensive adherence counselling in east central Uganda: A COM-B model-informed qualitative study

Résumé fourni par la source

Suboptimal viral load (VL) suppression among adolescents and young people living with HIV (AYPLHIV) remains a major challenge to HIV control in Uganda. Although Intensive Adherence Counselling (IAC) is implemented as a structured intervention for individuals with unsuppressed viral loads, suppression rates among AYPLHIV remain low. Evidence on the contextual factors shaping VL suppression after IAC remains limited. This study explored barriers and facilitators to optimal adherence and engagement in IAC as a pathway to VL suppression among previously non-suppressed AYPLHIV aged 10-24 years who had undergone IAC in East-Central Uganda. A descriptive exploratory qualitative study design was conducted among participants purposively sampled across four districts. Data collection and analysis of individual-level factors were guided by the Capability, Opportunity, Motivation - Behaviour framework, while health system factors emerged inductively and complemented the COM-B framework. In total, 8 AYPLHIV, 4 caregivers, and 10 health workers participated. Interviews were audio-recorded, transcribed verbatim, translated into English, and analyzed using thematic analysis. Most participants (64%) were female, and the median age of AYPLHIV was 16.5 years (interquartile range [IQR]: 14.5-20.5). Multiple individual-level factors influenced VL suppression. Capability barriers included forgetfulness, while facilitators included reminder routines. Opportunity barriers comprised economic hardship, parental resentment and social class-based reluctance, and non-disclosure of HIV status, whereas caregiver support was a facilitator. Motivation barriers included emotional distress and substance abuse, while facilitators included future aspirations and religious beliefs. Health system barriers included a rigid IAC delivery schedule, and long waiting time, whereas peer support and WhatsApp groups acted as facilitators. The findings highlight the need to redesign IAC from a predominantly facility-based intervention to an adolescent-responsive model that integrates peer-led engagement and flexible community-based service delivery to optimize viral suppression among high-risk AYPLHIV. Key words: viral load, intensive adherence counselling, suppression.

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